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    Travel details

    AGE*

    TYPE OF PROGRAM

    ARRIVAL DATE

    DEPARTURE DATE

    Personal Details

    Title (Mr,Mrs,Miss,Ms etc...) *

     

     

    Passport country *

    Gender*

    First name*

    Family name*

    Birth date *

    Country of birth

    Marital Status *

    Home Address

    Postal Address (if different)

    Region/Count *

    Postal Ccde*

    Country*

    Phone/Mobile*

    Email*

    Personal Details

    Please give details of the last two educational establishments attended.

    Educational Qualifications

    Please state your level of English.

    Advance

    References

    Please give details of two people we might contact for references

    Title (Mr., Mrs., Ms., Dr., …)

    First Name

    Last Name

    Address

    Phone

    Title (Mr., Mrs., Ms., Dr., …)

    First Name

    Last Name

    Address

    Phone

    Sponsor details (who is going to pay for your fees?)

    Relationship

    First Name

    Last Name

    Address


    Phone

    Email

    - Please complete all sections and include the fees.

    - Places can only be reserved once full fees have been received.

    - Please note that registration & administration fees are not refundable.

    - Administration and registration fees GBP100.00

    Residence Status

    Do you need a visa allowing you to stay in the U.K.?

     

    If Yes, please give details.

    If Other, please explain.

    Have you ever been refused a visa to the U.K.

    If Yes, please give details.

    Health

    Do you have any medical condition?

    If Yes, please give details.
    You can refer to the list below

    Visual impairment

    Hearing impairment

    Disability affecting physical mobility

    Other (Asthma, Diabetes, Epilepsy,…)

    Emotional or behavioural disorder


    Mental illness

    Temporary disability after illness or accident

    Asperger's syndrom

    Moderate or severe learning difficulties

    Dyslexia

    Dyscalculia

    Other learning difficulties


    Have you received any special learning support at school? (eg. Have you had extratime in exams or a statement of educational need?)

    If Yes, please give details.